[epistemic effort: I went to like six therapists that didn’t suit me before I figured this out]
If you’re like me, you’re crazy and prone to researching your own craziness, which means you probably have strong opinions about your psychological treatment.
If you’re treating your craziness with drugs or lifestyle interventions, it’s usually pretty easy to tell whether you’re getting the treatment you want: you just look at the name of the drug you’ve been prescribed or observe whether or not you’re going to a yoga class or sitting under a lizard lamp. On the other hand, in my experience, it’s very easy to get a therapist who claims to be providing the service you want, but who isn’t really.
If you’re looking for a CBT therapist, you might go to Psychology Today’s Therapist Finder and look for therapists who claim to have expertise in CBT. The problem with this is that many therapists are eclectic, which means they use techniques from a bunch of different schools of therapy. To be clear, there’s nothing wrong with eclectic therapy: it can offer a lot of flexibility, so that if something isn’t working for you your therapist will feel free to try something else. To some extent, a therapist who only does CBT is like a psychiatrist who will only prescribe one drug. And some people believe the active ingredient in therapy is a kind, empathetic, high-status person who listens to you talk about your problems and helps solve them: eclectic therapists can provide this service was well as anyone else.
However, eclectic therapists– in my experience– typically list every kind of therapy they sometimes use as a kind of therapy they provide. That makes sense– after all, they do provide all of those kinds of therapy, at least sometimes. But if you’ve done the research and you really think your depression would be responsive to CBT and CBT alone, the profusion of eclectic therapists who say they do CBT means it’s a lot harder to find a therapist who will just do vanilla, manualized CBT. And it’s very easy for a person to believe they’re getting standard CBT when in reality they’re getting eclectic therapy.
How do you avoid this problem?
First, try looking for an organization that advances your preferred form of therapy; they may have a directory of therapists. For instance, Behavioral Tech’s website has a list of therapists they’ve trained in DBT. I currently go to a therapist listed on this website and she does DBT straight from the manual. (It’s great.) Not all therapists who practice a particular school of therapy will be listed on any website; even if the closest person is far away, consider calling them to get a referral.
Second, familiarize yourself with what your therapy is supposed to look like. If you’re going to a therapist for DBT and you’re not in a skills group, you don’t have to fill out a diary card, and you’ve never done a chain analysis, you’re probably receiving eclectic therapy, not DBT. If you’re going to a therapist for CBT and you don’t have to fill out innumerable tedious worksheets, you’re probably not actually in CBT. For manualized therapies, consider purchasing the actual manual– it’s costly, but you’ll know what you’re supposed to be getting and be ready to jump ship if you’re not getting it. If it’s impossible to find a list of therapists who actually perform your favorite therapy, you can brute-force it by going to every therapist who claims to practice [insert therapy here] and then dropping any therapist who appears to not actually do so. (For efficiency purposes, it is probably best to have intakes with two or three therapists at a time; the therapists will not be angry at you for doing this, although it can get really expensive.)
Note that it is likely that non-eclectic therapists will be more expensive, farther away, and less likely to take your insurance than eclectic therapists.
I’d like to reemphasize that there’s nothing wrong with eclectic therapy. It’s helpful to lots of people! That’s why there’s so much of it! But I do think more people should know that just going to a therapist who says they practice CBT/ACT/DBT/psychodynamic therapy/whatever does not mean you will actually receive CBT/ACT/DBT/psychodynamic therapy/whatever.